Syncope Management Guidelines at work: first steps towards assessing clinical utilityThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.

Abstract

This editorial refers to ‘Hospital admission of patients referred to the Emergency Department for syncope: a single-hospital prospective study based on the application of the European Society of Cardiology Guidelines on syncope’† by A. Bartoletti et al ., on page 83 and ‘A new management of syncope. Prospective systematic guideline-based evaluation of patients referred urgently to general hospitals’‡ by M. Brignole et al ., on page 76 Management of patients who present after an apparent transient loss of consciousness (TLOC) and who are suspected of having had true syncope remains a clinical challenge; one that is often first confronted by emergency department (ED) and hospital-based physicians. As a first step in assessment of these patients, it is essential that other conditions associated with real (e.g. seizures and concussion) or apparent (e.g. narcolepsy and certain psychogenic disturbances) TLOC, but that are not syncope, be excluded. Syncope refers specifically to TLOC caused by self-limited inadequacy of cerebral perfusion.1,2 Thereafter, attention must be directed towards establishing the most probable cause for syncope; only then can an appropriate treatment strategy be developed.1,3 In terms of TLOC in general, and ‘true syncope’ in particular, conventional diagnostic strategies have long been fraught with confusing terminology,2 incomplete history taking, and inappropriate reliance on excessive laboratory tests; the outcome has been costly with poor diagnostic yields.1,4,5 Clinical guidelines were clearly needed. The European Society of Cardiology (ESC) Syncope Task Force published the first set of guidelines on the management (diagnosis and treatment) of syncope in 2001, with the most recent update being issued in 2004.1 In addition, the task force published a succinct handbook designed to facilitate clinical application of the recommendations; the first edition was released in 2002 and a revised version is due … *Corresponding author. Tel: +1 612 625 4401; fax: +1 612 624 4937. E-mail address : bendi001{at}umn.edu